Can Chronic Pain Be Cured?

Over 50 million people in the US are suffering with chronic pain, but many of them don’t have to be. Recent studies have shown that often chronic back pain, neck pain, fibromyalgia symptoms, carpal tunnel syndrome, migraine headaches, and many other forms of chronic pain are not the result of structural causes, but of learned nerve pathways in the brain.

John Sarno, MD, was one of the first physicians to hypothesize that many forms of chronic pain are reversible. He referred to this condition as Tension Myoneural Syndrome (or TMS). Working with other colleagues, he developed a protocol to treat chronic pain with a high rate of success. Three formal retrospective studies conducted at the Rusk Institute of Rehabilitation Medicine at New YorkUniversity found that of 371 randomly selected chronic pain patients, 72% reported being free or nearly free of pain six months to three years after treatment.

As a psychotherapist specializing in the treatment of chronic pain and a board member of the Psychophysiologic Disorders Association, I have worked with a team of physicians and psychologists to further hone this treatment protocol and help pain sufferers eliminate or significantly reduce their symptoms. Because some people do not have access to a practitioner specializing in this model, I’ve used the treatment protocol to create a free online recovery program.

The TMS Wiki, a nonprofit advocacy group that aims to raise public awareness for this treatment model, has posted the online recovery program to help chronic pain sufferers work toward eliminating their symptoms. The program incorporates psycho-education, written exercises, and segments of recorded sessions to help users literally alter their neural pathways and break the pain cycle.

When pain sufferers are initially told about this condition, that their symptoms may not be the result of structural damage, a common response is, “Are you saying that the pain’s imaginary?” The answer is an unequivocal, “No.” The pain is most definitely real. But just as pain can be learned, it can be unlearned.

Having personally experienced years of chronic back pain (diagnosed with a herniated disc), and headaches (diagnosed with high cerebrospinal fluid pressure), I remember the desperate desire for relief. With each new treatment, a feeling of hope; and with each failed treatment, crushing disappointment. I lived with the fear that my pain would never go away and the confusion over how my body could be so fragile.

Having eliminated my symptoms, and working with many others who have as well, I’ve found that most chronic pain sufferers have the capacity to break free from this condition. It’s just a matter of finding the right tools.

Alan Gordon

Alan Gordon is a licensed clinical social worker (LCSW), psychotherapist, and the Director of the Pain Psychology Center in Los Angeles. He is an adjunct lecturer at the University of Southern California, has authored publications on the treatment of chronic pain, and has presented on the topic of pain treatment at conferences throughout the country.

Alan served as the chair for the 2010 Mind-Body Conference in Los Angeles and co-created the the treatment outline for the Psychophysiological Disorders Association.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

John Quintner, MD, a physician in rheumatology and pain medicine June 17, 2013 at 6:22 pm

@ Stephen. You appear to have missed the point of Dr Loeser’s argument. He wrote it because modern medicine has failed to assist so many people suffering from persistent pain. As for dry or wet needling of “trigger points” in muscles, the weight of scientific evidence lends no support for this modality of treatment.

(1) lack of evidence for treatment outcomes; -First you have to believe and trust the patient is in pain. If you refuse to look them in the eye and talk to them, in 2013, we will get nowhere in the complex cases. Watch the videos.

(2) inadequate education of primary health care providers;- Med schools are geared toward “vending machine” medicine … complaint, diagnosis and a pill. NO exams are being done!!! I have many patient who have had knee or hip replacement surgery who still had pain. They hobble into the office, get a few diagnostic and therapeutic trigger points shots and balanced dry needle points and walk out 50% better. “Doctor, the surgeon never touched me at that tender area” said the happy patient. “Gee, you think I needed to get my joint replaced”

(3) the largely unknown value of opioid treatment for patients with chronic non-malignant pain;-Because of vending machine medicine the protocol is tylenol, Nsaids, opioids; MRIs Joint injections and then on to surgery. They never can get off the opioids even after the surgery because the primary myofascial issues is still causing pain.

(4) funding availability for health care providers;(5) access to multidisciplinary pain centres.-funding comes from the most powerful folks in medicine … Surgical and orthopedic suppliers and pain and related manufacturers – These conflict are obvious to everyone. I saw a bill to medicare for injections, my office visit is 75-125 dollars. They charged 1000 for the shots and 11,000 for the surgical suite charges!!! Medicare paid 90% of the suite charge!!!! No wonder, in my zipcode dozens of these suites have opened and the parking lots are full. Abuse is rampant.

Outdated theory to guide their clinical practice.– I wish, the “new dated” procedures are ripping a hole in the fabric of pain therapy. I just saw a guy who has neuropathy was going to a new fangled pain clinic, 3 x week for 2 months for injection and some type of E-stem … he had 20% improvement.

Myofascial Release therapy and Mind-Body-Spirit exercises are basic therapies are not extremes. PT is as old as humanity, the mind-body-spirit is as old as humanity. IMO, they have been marginalized and bastardized by foul intent.

You see my friend, if modern medicine was as effective as imagined than magic surgery and magic pill would have fixed all of our ills.

We need an open dialogue not with data miners, data researchers, editors, proofreaders, word jugglers, truth-twisters and talk directly to patients unaltered by egos and profits.

You all may be interested to know that Dr John Loeser, one of the founding fathers of the International Association for the Study of Pain (IASP), recently identified five crises in contemporary pain management that require urgent attention: (1) lack of evidence for treatment outcomes; (2) inadequate education of primary health care providers; (3) the largely unknown value of opioid treatment for patients with chronic non-malignant pain; (4) funding availability for health care providers; and (5) access to multidisciplinary pain centres.

There is in my opinion yet another and in some ways more fundamental crisis that needs to be recognized and addressed. This is the tendency for practitioners across all specialties to employ outdated theory to guide their clinical practice.

So far, in this discussion, we have seen the two extremes of thinking being employed to guide therapy: (1) there must always be a structural basis for chronic pain (as exemplified by Trigger points); and (2) that psychological mechanisms can explain pain that does not appear to have a structural basis (as exemplified by Alan’s approach).

There may be elements of truth in both approaches but the whole discussion rapidly becomes bogged down by the vexed issue of body/mind dualism that has been attributed to Descartes. In other words, if we cannot find the lesion within your bodily structures, it must reflect a disorder of your mind.

Until we are able to transcend this form of dualistic thinking we are condemned to perpetuate forms of treatment that have been clearly shown to be relatively ineffective for many of our patients with chronic pain. Some forms of treatment we know to be decidedly harmful, as everyone now accepts.

People are suffering while the erudite debate what they think and believe. Beliefs and bias have caused considerable pain and lives in the world. Words are a poor way to communicate. We need complex thinkers. We need visionaries. We also need worker bees too. Most of all we all need to establish what works and implement those idea. One important issues is that pain is invisible and thus can be discounted and ignored by insurance co. and the litigation process. This goes into the profit margins of these establishments … so profits are derived on the suffering.

The people you are addressing with this sales article are probably somewhere within our ranks, but it is entirely insensitive of you to address this to all of us, the 50 million of us in chronic pain. I don’t know who out there has pain without any “structural” reason, except those undiagnosed, poor souls who are being told as we speak that their pain is “in their head” and will have to wait, possibly years, to get to the truth, but you should really find a better way to approach even the small market segment you’re looking for.
It is worse than the “come on” from a car salesman, who makes it seem he has the answer to everybody’s problems, which is terrible in itself, but to say to a pain patient, in a broad, general sense, that their problem and their pain is totally psychological is to completely misunderstand us. I can tell from your approach that you haven’t been around a lot of people in true chronic pain.
By implying this crude and simplistic approach you are hurting those who had to go through the gauntlet of misbelievers, their friends and family, their doctors and insurance agents, and the years it took for someone to approve tests to show the real cause of their pain. This in itself has caused more psychological damage to those in pain than anything their childhood could dream up. You would think doctors would know better, but to them it is simply a vague answer to a complex problem. What Hippocrates said was, “First, you shall do no harm.” Think about that. And you’re into psychology! Why would you want to prey on the one thing a pain patient has to live with permanently, validation? You are speaking directly to all those, like myself, who waited years to get diagnosed and to those who are still waiting.
What do you say to all those “sciatica” patients who had as of yet undetected fractures and spine injuries, or those hypochondriacs actually suffering from Lupus or Lyme’s disease, or the “fakers” looking for a reason to be lazy and wanting attention until they finally discovered their RSD problems. The list goes on and on of actual, structural causes for chronic pain as yet unnamed or undiscovered. What about the ones, like myself whose doctors and insurance agents had a reason to drag out the diagnosis process and actually falsified documents to make it seem that they suffered from somatization and anxiety because they didn’t want to accountable for the testing and surgeries and lifelong medical treatments necessary for their very real diseases.
During this illegal and highly unethical process we lost everything, our jobs and insurance, our homes and families, all of our monies and support and to this day those words still sting deeply, “it’s all in your head. Think about what you’ve been through in your life. No wonder you’re in constant pain. You need to deal with your demons.” I should have known they were lying when they never once referred me to a psychiatrist. I had to find out by seeing my medical records.
What do you say to those labeled in corrigible by their doctors because they ask for a copy of their records, or secretly write in your records that they think you’re an addict looking for free drugs? What do you say to those labeled uncooperative because they ask for a second opinion or refuse a certain drug? Even if these labels are cleared from the records they stay with the patient. They cause mounds of self-doubt and create tons of self-esteem issues, and they never go away. They just stay hidden until some “professional” unwittingly steps on them and the poor patient, as if chronic pain wasn’t enough of a punishment, now has to go through the self-doubt all over again.
For every person suffering from a psychosomatic pain there are ten of us being told this who will at some point find out the true reason for their pain. Then they will definitely need pain counseling, not psychotherapy. But then again, this article you wrote just set back pain counseling another 10 years. Why don’t you try hanging around pain patients awhile, try working in a pain clinic or visiting the shelters or the streets and talk to some people in pain? You may realize that true pain counseling begins with the words, “Your pain is real and physical and I believe you.” If you can truly win over the trust of a real pain patient, or if I can educate enough of them as to how to spot the professionals who really care, you may be able to do some good. You may be able to get to their demons, after of course you help rid them of their demons caused by the system, or what we call “Pain Treatment.” Good luck with that.

I do see your point. Although pain is certainly an experience, the mind can use it to serve a psychological purpose as well. That’s what I meant by behavior, but we may just have different interpretations of that term.

The unconscious mind is actually the entity that has the capacity to change psychological strategies. The pain is just the tool that it uses.

Dear Alan. In effect, you appear to be reifying an experience (“pain”) and then conferring agentive properties upon it. For example, you say that “pain serves to protect the mind …” and that it can “move to a different part of the body; a change in strategy”. Can you see my point?

In your example, I suggest that it is behavior and not pain that is being reinforced. Care to comment?

Hi John,
I didn’t mean to imply that the pain sufferer was behaving as if they were in pain, but that the pain itself is serving as a behavior.

Just as a toddler throwing tantrums to get candy can be seen as a behavior with a specific purpose, the pain can similarly serve as a behavior. This isn’t to say that the part of the brain that generates pains has intention, but it can serve as a behavior nonetheless.

When the parent stop reinforcing the toddler’s behavior by withdrawing the reward (candy), the behavior changes as its purpose is no longer being served. So it is with pain in many cases. When clients recognize that the pain is serving an underlying purpose (one theory is that the pain serves to protect the mind from difficult-to-tolerate emotions), and then change their response to the pain (withdrawing the reinforcement of fear and preoccupation), the pain often dissipates.

When the pain is no longer getting reinforced, sometimes it will actually move to a different part of the body; a change in strategy. Like how a toddler who is no longer getting their candy might go from screaming to holding their breath.

This behavior change often works, as the pain sufferer, who may have overcome feelings of fear and preoccupation with their back pain, are scared all over again about their new knee pain.

Once they learn to identify this pattern, pain sufferers can overcome their fear of the pain and recognize that any shift in symptoms is nothing more than their unconscious mind attempting to hold on to this defense mechanism.

Regarding your question about learned nerve pathways, I’m clearly out of my league. I’ll reach out to Howard Schubiner who is much more equipped to discuss this issue, to see if he might respond.

Alan, surely there is a distinction to be drawn between a person’s report of “being in pain” and, to an observer, that person behaving as if he or she is in pain.

As an analogy, we can be in love but that experience may or may not be obvious to another person who is observing our behavior.

I am aware of the outstanding contributions made by the neuroscientists that you have listed. My point here is that “learned pathways” should not be allowed to morph into “pain pathways,” because the latter do not exist. I accept that this was not your intention.

My response was for patients who wish to understand how pain can evolve from simple to complex. I want to help them see how pain if left alone or treated with just a pill will set themselves up for more suffering. They have to establish a buffer and protect themselves from that miserable fate be establishing a consistent wellness, balance and vitality program.

I also wanted to stress to them that modern medicine already have therapeutic modalities that really work. I see about 75 cases a week, which are some of the most complex from Migraines, TN, Torticollis, RSD, RA, FM, DJD, and neuropathy. I have to say that all pain levels drop by 40-50% to complete resolution of the pain.

My most disheartening cases are the patients who fail surgical procedures. The ethical and possible legal issues is that none were ever offered proper informed consents. They were not given all the possible proper therapeutic options prior to having joint destruction surgery. What is even more disturbing is even after the failure they we just dumped into the pill pain clinics and written off as malingerers or crazies or addicts or as statistics. Some of the patients I see have been in severe life altering pain for 2-10 yrs! I’m constantly telling them that they will be OK and that they do NOT need to get a lawyer because of the tort reform laws in Texas are not in their favor.

For the academics who want to debate the minutia and attempt to figure out how God works, I point them to the vast world of the web. I have minimal time to debate, there are protocols already that are being used to help folks in pain. Naysayers, please get out of the way!

Pain that is complex, requires therapy aimed at the mind, body and the spirit. Leaving any aspect out will possibly delay recovery and do harm.

To address your follow-up post John, in my experience sometimes pain is most definitely a behavior. In fact, the majority of clients I’ve worked with have a more dramatic response to a behavioristic approach (reframing their interpretation of the pain, both in terms of cause and purpose, as well as gravitating from a sense of fear of their symptoms toward a sense of empowerment) than any other approach.

Often utilizing a psychodynamic approach is an important component of maintenance, but a behavioristic approach can be sufficient in and of itself to eliminate or reduce symptoms.

That being said, I don’t believe that pain is always a behavior. But in many cases it is.

Hi John,
Good questions. Dr. Sarno eventually came to believe that the term TMS was not an accurate reflection of the physiological processes, but by that point the term had gained so much popularity, he felt it would be counterproductive to change it. Other practitioners refer to the condition as psychophysiologic disorder.

Though Dr. Sarno conducted several retrospective studies, Howard Schubiner of Providence Hospital in Michigan has been conducting randomized controlled studies over the past few years. He is currently involved in an RCT study involving fibromyalgia patients.

Regarding evidence to support the existence of learned nerve pathways in the brain, I’d suggest Hebbes (neurons that fire together, become wired together), Kandel (learned fear in a small marine snail), LeDoux (the emotional brain book), Kross (both physical and emotional inputs activate the same brain regions), and Wager (specific pain signature patterns in the brain).

As a clinician, I’m focused more on the treatment than the research, but I’d be happy to put you into contact with some of the physicians who have a greater level of expertise on the evidence behind this theory.

Stephen, you appear to have hijacked this discussion in favour of your own folksy nonsensical stories – “Something happens in the healing process that leaves a scar or healing defect. These defects are called trigger points (TP). A myofascial TP injury (weed) will grow deeper and the “plant” will spread across the body and eventually the seeds will spread to the whole body.”

Dr Sarno’s huge contribution to the issue of treating chronic (spinal) pain was to shift the emphasis away from structural pathology towards underlying psychopathology. He did suggest that unresolved emotional conflicts could be played out in voluntary muscles that were persistently contracted (“tension”) and thereby deprived of their blood supply. An oxygen debt ensued, as did localized muscle pain. This, he postulated, was how one’s mind could influence one’s body.

Such a mechanism has never been shown, although an increase in electrically recorded spinal muscle activity has been shown to occur experimentally when people with low back pain relive significant (for them) emotional experiences.

Dr Sarno’s approach to treatment was entirely based upon the application of psychodynamic principles, that had been developed by others over a number of years.

Alan’s post deserves to be more fully discussed and it was in this vein that I posed my questions. My response to Alan is to suggests that behaviour is a learned process, and therefore changeable. This is not a controversial issue.

However, to reframe the lived experience of pain as a “behaviour” is, at least in my opinion, an error. However, having said that, our better understanding of the property of synaptic plasticity (see “The Brain that Changes Itself) has opened up the possibility of new and creative ways of helping people to better manage their pain.

Simple pain problems usually will heal without much human intervention. Ankle or shoulder sprain, pulled back, etc. This God given healing ability is subconscious and natural, but truly overlooked and discounted. All is needed is rest, heat, stretching and massage. Taking anti-inflammatory and Tylenol will allow for comfort during this healing process.

Given certain circumstances a simple issue will evolve into a more complex entity. Why? It just does. Today, I really don’t need to know the molecular-chemistry of that conversion. What I really want to know is how to keep it from happening and how to reverse it once it does.

For some reason the human muscles of locomotion have a remarkable ability to withstand tons of kinetic energy and still recover for future survival. Something happens in the healing process that leaves a scar or healing defect. These defects are called trigger points (TP). A myofascial TP injury (weed) will grow deeper and the “plant” will spread across the body and eventually the seeds will spread to the whole body.

What’s missing?
Common sense as it related to the historical evidence. We know complex pain can NOT heal with only a pill and time. A pill can help with comfort only. We have been programed to think that the pill will heal and that is all we need to do. NOT! It will buy time and help the injured person be more comfortable during the healing process. A danger is the pill will allow the patient to “think” that all is well while the injury festers.

A musculoskeletal injury require therapy in the form of effort or energy. Heat energy, manual energy, leverage energy, counter-strain energy to pull the muscle fibers from tight bundles into long and more flexible fibers. No effort will allow the injury to smolder and seed.

What is needed?
A recipe of ingredients that will treat the pain and restore the patient’s well being. Leave any part to the ingredients out and the results will be less than optimal. Therapy; daily, weekly and monthly. The tools need to be from our arsenal of weapons. Heat, stretching, vits, minerals, pain will disrupt sleep so sleep aids are needed. Pain will corrupt wellbeing, so we need to address these issues. Pain sill disrupt family, work and social dynamics … all these may have to be addressed.

Complex pain problems are treatable with the correct tools. Patients need a comprehensive team of providers to assist because it is time consuming and labor intense. Combining all these modalities in a recipe is the best option to ignite and keep the healing going.

What happens with no, poor effort and therapy?
Over time under continued stress, the myofascial tissues will become even more erratic, spasm, tight, stiff and dense. Just like leather! Once the MF tissues are this dense physical energy will not completely unlock the muscle. NO matter how muscle effort is applied. Misery prevails, but there is a tool that can rescue this leathery muscle tissues and that is a the electro-mechanical energy that is ignited when a wire is inserted into the mix. Bling! The muscle is re-depolarized as per Cannon’s Law. The re-depolarized muscle will be awaiting the new programming which is the complete therapy package; heat, stretching massage, Vitamins, minerals trace elements and wellness, mind body and spirit.

Patients in pain need help now so we need to use the tools we have available now. Why are we allowing effective pain therapies to sit on the sidelines while we study/research/deny/cross examine vetted treatments that are ancient? Denial is rampant! This is also disrespectful to patients and all the prior authors of pain theories.

I summarize that to keep a simple pain injury from evolving into a complex injury, we need to attack with the full force of every weapon in our arsenal when it’s a small seed before it grows into monstrous weeds.

This approach changed my life. For 18 years, I suffered from chronic pain, diagnosed as fibromyalgia, myofascial pain syndrome, repetitive strain injury, and thoracic outlet syndrome. There were so many activities that I couldn’t do that my life felt completely circumscribed. I was scared of hurting myself and scared about whether I would ever be able to support myself.

Now I feel like I have my life back. This program didn’t exist when I was healing, but it’s very similar to what I did and I’m going through it now to work on other symptoms. It’s free and I can already see it helping.

The link to the recovery program is a little hard to find above, but if you just Google “TMS Recovery Program,” it will be one of the top links.

Stephen, as you well know, “myofascial release therapy” rests on the shakiest of scientific foundations (and I am deliberately stretching the bounds of credibility in your favour). If you already have access to the “most powerful tools in Medicine,” why do you see the need to endorse Alan’s approach? In this post, you appear to be saying “when all else fails, break out the needles.” Am I misreading you?

This is powerful information and of great value to anyone who has chronic pain. Chronic pain will affect your entire life, sleeping habits, family life and dynamics, social life, work and will test you spiritually. The pain will alter cell chemistry and neurotransmitters which will rearrange tissues at the molecular level.

This program reminds me of the stress reduction program created by Jon Kabat-Zinn which is mind, spirit and mindfulness training. His program is over 30 yrs vetted to be highly effective at treating stress, trauma and chronic pain.

My patients always have been told or think, “Is this in my head?” I tell them, YES!! It is in your head … PLUS in your brain, nervous system, flesh and soul … it traumatizes your whole being.

To begin treatment of traumatized patient, you first have to reassure them that they will be safe, have less pain and that they will not die a miserable painful death. Then you must have the tools and wisdom to address all of their pain issues.

Chronic pain patients usually will have multiple pain sites over their body, from headaches, neck and shoulder issues. If they have lower back pain, they will usually always have hip and lower extremity misery. To save these stressed-out folks time, travel, effort, money, co-pays and more headaches. Having the most powerful tools in medicine will begin the healing.

Myofascial tissue release therapy is on a spectrum from simple stretching, yoga, Pilates, hands-on manipulations, acupuncture, dry needling to finally Travell trigger point injections.
Complemented MF work with a wellness program, supplements and mindfulness work will restore these patients to a more harmonious life.

Alan, you appear to believe that the answer to your question – Can chronic pain be cured? – is in the affirmative. I have some questions to ask of you before exploring your extraordinary claim in more depth:

1. What exactly did Dr Sarno mean by “tension”? Was he referring to muscle tension? Did he ever formulate a scientifically testable hypothesis? Or were his ideas expressed only as conjectures?

2. Where can I find evidence to support the existence of “learned pathways in the brain”?